Pregnant? Blood Pressure Taken Incorrectly?


Photo Description: A doctor taking a patient's blood pressure.  Camera is looking down from above table.
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My pregnant partner had issues with white coat hypertension that caused us a lot of stress because the OBGYN wanted to induce early based on bad blood pressure data.  If you are in this situation, I wanted you to have some research that I conducted.

Fyi, you can find things that would be behind an OVID paywall by finding publically accessable documents that reference what you want.

My partner's OB is a member of ACOG.  After a lot of searching, I found the practice bulletin that describes best practices for taking blood pressure.  In my experience, no med tech follows these because no doctor requires it.

Of course, Pre-eclampsia is extremely dangerous.  However, at least one doctor is not ensuring that they make judgements on good blood pressure data.

I hope you can use this to advocate for yourself.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720658/figure/F3/


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Text in photo: 


Hypertensive Disorders of Pregnancy Apurva M. Khedegi. MS and Natalie A. Bello, MD, MPH


PMCID: PMC7720658 NIHMSID: NIHMS1632929


MEASURING BLOOD PRESSURE IN PREGNANCY


PMID: 33222817


As previously described, each trimester of pregnancy involves marked hemodynamic changes, so the accurate measurement of blood pressure in pregnant women is essential for the diagnosis and treatment of hypertension. Although considered the gold standard for blood pressure measurement, the mercury sphygmomanometer is rarely available in the modern clinical setting where oscillometric devices are in widespread use. Note that all blood pressure monitor validation protocols recommend devices be specifically validated for accuracy in pregnant women in light of the previously mentioned alterations in the vasculature that occur and that may result in inaccuracies. Best practices for blood pressure measurement include taking blood pressure using an appropriately sized cuff, in a patient with an empty bladder, preferably at least 30 minutes after ingestion of caffeine or nicotine use, and after 5 minutes of quiet rest. The patient should be comfortably seated with uncrossed feet resting on the floor, in a chair with appropriate back and arm support, with the arm comfortably resting at the level of the heart (Fig. 3),1112


Causes


Effect on Blood Pressure Reading


Too large: decreases by 2-10 mm Hg


Too small: increases by 2-10 mm Hg


Increases by 5-50 mm He


Increases by up to 10 mm Hg


Improper cuff size


Improper cuff placement


Talking during measurement


Patient positioning:


Unsupported back or improperly supported arm


Feet not resting flat on floor


Arm not supported


Increases by 10 mm Hg


Fullbladder


Increases by 10 mm Hg


3


Identifying inaccuracies resulting from improper blood pressure measurement


11. ACOG practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019:133(1): 626-50. [PubMed] [Google Scholar]


12. ACOG practice Bulletin No. 202: gestational hypertension and preeclampsia. Obstet Gynecol 2019: 133(1):e1-


25. [PubMed] [Google Scholar]

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